Bucking the Trend: Preventing Childhood Obesity

By Alison Ventura, PhD

We've all heard about it - the number of U.S. children classified as obese has increased
dramatically over the past 30 years. In the 1970's, only around 1 in 20 children were classified as
obese, whereas the most recent surveys show this proportion has tripled.1 Obese children are at
higher risk for a whole host of problems that were once thought to only affect adults, such as type
2 diabetes, metabolic syndrome, and heart disease. These scary statistics mean families need to
be aware of the factors that contribute to childhood obesity so they can encourage healthy habits
and growth patterns early on.

Vegetarian families have a head start on preventing childhood obesity, as research shows
vegetarian children and adults tend to be leaner than their non-vegetarian peers. In fact, in
a position statement released July 2009, the American Dietetic Association (ADA) concluded
appropriately planned vegetarian diets are healthful, nutritionally adequate, and may prevent and
treat certain conditions, such as heart disease, obesity, hypertension, type II diabetes, and
cancer.2 However, the development of childhood obesity is complex and does not arise
from only one or two behaviors (for example, drinking soda or watching television), but from a
great many factors that occur throughout a child's development. Thus, although the ADA's statement
suggests a vegetarian diet is a great first step towards preventing childhood obesity, there are
even more steps that can be taken to further reduce the risk of childhood obesity.

Obesity develops when too many calories are consumed relative to the amount of calories used,
which can happen regardless of whether children are eating a vegetarian or a non-vegetarian diet.
There are contributors to childhood obesity at each developmental period. By being aware of how
actions and choices can contribute to childhood obesity, families can be ready to make as many of
the best choices as possible.

Pregnancy

An incredible amount of growth and development occurs in the womb, so this is a prime time to
give children a healthy start! There are several steps pregnant women can take to decrease their
unborn children's risk for obesity later in life. The main focus of research in this area has been
on factors that influence infants' birth weights because infants born too small or too large have
an increased risk for obesity later in life. Very low protein diets increase the risk of having a
baby with a low birth weight, while diets that are very high in carbohydrate or in fat can lead
to a very large baby. Additionally, children whose mothers smoked during pregnancy or who were
overweight before or during pregnancy are at increased risk for obesity. Pregnant women, or women
planning to become pregnant soon, can work with registered dietitians to create vegetarian eating
plans that ensure adequate amounts of calories, fat, protein, vitamins, and minerals. For more
information about vegan diets during pregnancy,
see http://www.vrg.org/nutrition/veganpregnancy.php

Infancy

Much research has shown that children who were breastfed during infancy have a lower risk of
being obese. We are still trying to understand exactly why this is, but it is probably because
the unique ratio of nutrients in and properties of breast milk help infants gain and maintain an
appropriate amount of weight during infancy and later in childhood. Breast-feeding may also help
preserve infants' natural ability to feed in response to hunger and fullness. Specifically, the
visual cues afforded by bottle-feeding (e.g., the amount of formula in a bottle) may make it
tempting for parents to encourage their infant to finish the bottle, regardless of whether the
infant is hungry for the whole bottle or needs that much formula. Because breast-feeding parents
do not have these same visual cues, they may be more attentive to the infant's expressions
indicating fullness and better able to trust their infant's ability to self-regulate intake in response to need.

Another benefit of breastfeeding is that flavors from the mothers' diet are passed to the infant
through breast milk (for example, if a lactating mother eats a garlicky meal, her infant will
receive garlicky milk). Although this may sound strange, this experience is actually very important
for infants to learn about the flavors and foods their families eat and helps infants be more
accepting of commonly rejected foods, like vegetables, during the introduction of solids. Getting
young children to accept healthy foods can be one of parents' and caregivers' biggest challenges
during infancy and toddlerhood; by breastfeeding and eating a wide variety of flavors and foods
during lactation mothers can help children be more accepting of healthy foods, and maintain healthy
weight gain patterns during infancy and later childhood.

Childhood and Adolescence

Portion Sizes

The average portion size of foods offered in most stores and restaurants has increased over
the past few decades. For example, 20 years ago the average bagel had a 3-inch diameter and
contained 140 calories whereas today's average bagel has a 6-inch diameter and contains 350
calories. Both children and adults tend to eat more when served a larger portion of food,
regardless of how hungry they are or how many calories they need. Educate yourself and your
children about what portion sizes are appropriate; the United States Department of Agriculture
(USDA) Food Guide Pyramid's website it a great place to start (www.mypyramid.gov). Additionally,
check out http://www.bcm.edu/news/packages/visualcues.cfm to learn some easy tricks for estimating
appropriate portion sizes for many typical foods (for example, a serving of raisins is ¼
cup, which is about the size of a golf ball). You and your children can even make a game out of
coming up with visual cues for portion sizes for your family's favorite foods.

Food Away from Home

In addition to coming in larger-than-necessary portions, restaurant foods, and fast foods
in particular, also tend to be higher in calories, fat, salt, and sugar, and lower in fiber, than
foods prepared at home. This means that even if your children eat a smaller portion of these foods,
they still may be eating more calories than they need. If your family's schedule makes taking the
time to prepare meals at home difficult, take advantage of the increasing number of ready-prepared
foods at your local grocery store. You can throw together a quick, healthy, and satisfying meal
in minutes by purchasing pre-washed, bagged salad greens; pre-cut vegetables in steamer bags;
marinated tofu; and quick-cooking grains. Additionally, as your children grow older and take more
control over their food choices, help them to recognize healthy choices at their favorite eateries.
The Vegetarian Resource Group's online restaurant guide (http://www.vrg.org/restaurant/index.htm)
has some great suggestions for vegetarian-friendly restaurants and the USDA has a variety of
resources to help you and your children make healthy choices when eating out
(http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&tax_level=3&tax_subject=358&topic_id=1611&level3_id=5972&level4_id=0&level5_id=0&placement_default=0).
Note that not all of the USDA's suggestions are geared to vegetarians.

Sweetened Beverages

The term 'sweetened beverages' is used to describe drinks like regular (non-diet) soda, fruit
punch or any fruit juice that is not 100% juice, or sports drinks. Increases in sweetened beverage
consumption have been associated with increases in obesity. The high-fructose corn syrup that
sweetens most of these beverages may contribute to excess weight gain. Additionally, children who
drink more sweetened beverages tend to drink fewer healthier beverages. Encourage your children to
drink water, fortified soy milk, low-fat or fat-free milk, or 100% fruit juice instead of sweetened
beverage (note that the American Academy of Pediatrics recommends limiting even 100% fruit juice
consumption to 4 to 6 oz/day for children aged 1 to 6 years, and 8 to 12 oz/day for children aged
7 to 18 years3).

Physical Activity

Regular physical activity is important for helping children stay fit and maintain a healthy
growth rate. The Centers for Disease Control and Prevention (CDC) recommends children get 60
minutes of moderate to vigorous physical activity (that is, activity that 'works up a sweat')
every day (http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html). Unfortunately,
many schools do not offer recess or physical education, or only offer PE a few days a week. Thus,
it is up to you to encourage your children to engage in some sort of physical activity after school
and on the weekends. Structured sports programs are a great way to keep children active, but
unstructured activities like jump rope, hopscotch, riding bikes, skating, walking the dog,
marching band, dancing, climbing or even active games like Wii or Dance Dance Revolution, all
fit within what the CDC considers moderate to vigorous physical activity. Even better, engage
the whole family in regular physical activity by planning active family time. Create a habit of
taking a walk together after dinner or going for hikes in your local parks on the weekend. Play
active games with your children and be a good role model by being open-minded about and enjoying
active endeavors. Active family time will both help your family bond and improve your family's health.

Screen Time and Sedentary Behavior

With all of the new technologies available, children are spending an increasing amount of time
in front of televisions, computers, or video games, and less time being physically active. Time
in front of TV and computer screens has been shown to promote childhood obesity in several
different ways: (1) children are less active (in fact, one study found children's metabolisms
are actually lower when watching TV than when resting!); (2) children are influenced by the food
advertisements that occur during commercials that are predominantly for foods high in fat, salt
and sugar; and (3) children who eat in front of the TV are more likely to snack on more energy-dense
snack foods, leading them to eat more calories throughout the day. Additionally, because it is easy
to "zone out" while in front of a TV or computer, studies have shown that eating in front of a TV
or computer screen may lead both children and adults to eat mindlessly, or to eat more than they
intend or need because they were distracted from their hunger and fullness cues. The American
Academy of Pediatrics recommends limiting children's television, computer, and video game time
to less than 2 hours per day. Also, encourage your children to separate eating and screen time
to help them avoid mindless eating.

Parents' Feeding Practices

Feeding practices are the choices you make about which foods you offer; when, how frequently,
and how much food you offer; and how you interact with your children over food. You can help your
children develop healthy food preferences and eating behaviors by employing feeding practices that
are patient, positive, and attentive to your children's hunger and fullness levels. Here's how:

With respect to the foods you offer: make a wide array of healthy foods readily available in
your home. Keep pre-cut and -washed fruits and vegetables in the fridge or on the counter and
encourage your children to choose them when they are hungry for a snack. Plan meals that include
a variety of vegetables, fruits, whole grains, and plant-based protein sources.

With respect to when, how frequently, and how much food you offer: set structured meal-
and snack-times for your family, and try to eat together as often as possible. Family mealtimes
are a great opportunity to interact with your children and teach them about wholesome foods,
healthy eating behaviors, and appropriate table manners. Additionally, be aware of the portion
sizes you serve (see the Portion Size section above) and allow your children to eat in response
to their hunger and fullness levels. Try not to restrict your children's intakes or pressure them
to eat, as these types of feeding practices can inadvertently teach children to eat in the absence
of hunger, leading to habitual over-consumption and excess weight gain. Talk to your children
about whether they are hungry or full and help them learn to pay attention to and eat in response
to these feelings.

With respect to interacting with your children about food, keep mealtimes positive and fun.
Adopt the attitude that feeding responsibilities should be shared between parents and children:
parents get to decide when, where, and what to eat, while children get to decide how much to eat.

Parents as Role Models

Parents provide their children with both genes and environments. Thus, overweight parents have
a higher risk for having overweight children than normal weight parents because these parents
may pass on genes that predispose their children to be overweight, as well as lifestyle patterns
and habits that also contribute to overweight. You can't change your genes, but you CAN change
your lifestyle patterns and habits! Adopt a 'do as I do' not 'do as I say' motto with your
children by maintaining healthy dietary, physical activity, and sleep patterns as a family.

Summary: 10 Tips for Preventing Childhood Obesity in your Family

Give your child the best start by maintaining a healthy diet and weight during pregnancy;
consult with a registered dietitian to make sure your pregnancy diet meets all requirements
for calories, fat, carbohydrates, protein, vitamins, and minerals.

Breast-feed to promote healthy growth, responsiveness to hunger and fullness cues, and
acceptance of a broad array of healthful solid foods for your infant.

Educate yourself and your children about what portion sizes are appropriate for their specific
nutritional needs. Serve these portions sizes on a regular basis.

Strive to cook balanced meals at home; if this is not possible, educate yourself about the
healthiest fast-food and food away from home options.

The contents of this website and our other publications, including Vegetarian Journal, are not intended to provide personal medical advice. Medical advice should be obtained from a qualified health professional. We often depend on product and ingredient information from company statements. It is impossible to be 100% sure about a statement, info can change, people have different views, and mistakes can be made. Please use your best judgement about whether a product is suitable for you. To be sure, do further research or confirmation on your own.

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